Article: Evaluation du risque thromboembolique et hémorragique dans la fibrillation atriale

L. FAUCHIER (1), Ch. SAINT ETIENNE, N. CLEMENTY

(1) Pr Laurent Fauchier, Service de Cardiologie, Centre Hospitalier Universitaire Trousseau,
37044 TOURS Cedex, FRANCE

Abstract

The value of oral anticoagulation for stroke prevention in atrial fibrillation (AF) is well established. Stroke risk assessment using the CHA2DS2-VASc score allows identification of patients who are at truly low risk (score=0) who should need no antithrombotic therapy, while all others (ie, CHA2DS2-VASc score ≥1 with a risk of thromboembolic event >1% per year) would be considered for oral anticoagulation. The HAS-BLED score has been recently proposed to easily assess bleeding risk in AF patients. A score of ≥3 indicates “high risk” and some caution and regular review of the patient are needed. It also makes the clinician think of correctable common bleeding risk factors. The new oral anticoagulants (direct thrombin inhibitor and factor Xa inhibitors) are at least as efficacious and safe as VKAs in non valvular AF. Their advantages are easier use with no monitoring, lower propensity for food and drug interactions, and lower rates of intracranial bleeding than with VKAs. They should not been used in patients with kidney disease at the present time. Overall, one may expect that more AF patients will be appropriately treated with oral anticoagulation in the next years.